Band-5 community nursery nurse (CNN) roles, offering leadership
opportunities, have been established in some primary care trusts (PCTs).
But despite interest from many CNNs in routes to progress their careers,
these remain scarce within the NHS. According to Unite/CPHVA's CNN
Forum, there are a very small number of senior CNNs in England, and no
record of them in Scotland, Wales or Northern Ireland.

A reason to train

Margaret Turner-Bone is one of the UK's few band-5 CNNs, and
states: 'No matter how much extra training a CNN undertakes, it is
not recognised and she will continue to be paid at the rate of a band-4
nurse. This could deter CNNs from undertaking any sort of extra training
that could be of benefit to the wider community.'

Unite/CPHVA CNN Forum chair Barbara Evans notes: 'Some PCTs
have created band-5 senior CNN roles, with greater leadership
responsibility, and this includes supervision and mentorship. However,
PCTs are providing nowhere near enough of these roles. A CNN would need
to change jobs or leave the NHS entirely if they wanted more
opportunities for career progression.'

She adds: 'Some CNNs have applied for other childcare roles in
Sure Starts and children's centres. Often, there is less
responsibility, they are paid at a higher rate, and there are more
chances for promotion to children's centre manager. These centres
are usually managed by local councils, but the lack of opportunity is a
major problem within the NHS.'

CNN leaders

Theresa Taylor was appointed as a band-5 senior CNN after NHS
Ealing recognised a gap in its community health service. She states:
'There was an increase in CNN applicants, who were needed to help
target the large numbers of hard-to-reach families in Southall
neighbourhood. The trust therefore developed the senior CNN role in
order to deliver induction training to new CNNs and to help provide a
universal family programme.'

Theresa provides support and advice to band-4 CNNs, health visitor
assistants and the children's services team. She provides supports
to CNNs in cases where there may be a complaint, and represents them in
senior management meetings.

Theresa has helped in the redesign of community services in NHS
Ealing and has developed CNN competences framework at a strateg level.
She also mentors, supervises and provides personal development plans and
appraisals for CNNs and health visitor assistants, conducts risk
management assessments, assesses health services and interviews for new
posts.

She notes: 'There is less health visitor input due to staff
shortages and because they have large caseloads to manage. In this
instance, collaboration between the senior CNN and health visitors is
important. Senior CNNs are not used to replace health visitors in any
shape or form--essentially, we help to enhance their role.'

Margaret Turner-Bone agrees: 'Senior CNNs usually mentor,
train and supervise other CNNs, which relieves some of the pressure that
health visitors experience. But only a few PCTs have employed a senior
member.'

Theresa states that her PCT has decided to roll the senior CNN role
out across the whole of Ealing. She says: 'NHS Ealing recognised
the necessity and benefits of having a senior CNN,and the PCT has so far
employed two more senior members. In addition, other trusts have shown
an Interest and I have spoken to a number of Other PCTs about my
role.'

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Although Margaret Turner-Bone was appointed as a band-5 CNN, she
says: 'Such opportunities for CNNs usually only come by
chance--there is no standard route for career progression.'

For her, it was after being appointed as a healthy weights project
lead at NHS Sefton. She notes: 'There was a lack of availability of
health visitors at the time that the trust was recruiting for this post.
The PCT therefore decided to open the position to those who had the
relevant experience. I was appointed to the role because I carried the
relevant skills, knowledge and experience, having worked in this area
alongside a health visitor in the past.'

Barbara Evans stresses the significance of employing senior CNNs:
'As well as providing induction training, supervision and advice,
senior CNNs would be able to effectively push forward the community
nursery agenda and represent the service. Senior CNNs will no doubt
provide the necessary support, especially in health visiting and
skill-mix teams.'

Registered service

Many CNNs seem to support the idea that the service should be
registered, emphasising possible outcomes such as post-registration
training.

Margaret Turner-Bone states:

'Community nursery nursing should be a registered service.
This would provide a standardised route into community nursery nursing
and it could even open up more opportunities for us to progress our
careers, where post-registration training could be considered.'

Concerns have been raised that a nursery nurse with insufficient
training in child care and early years education could consider
themselves to be a CNN.

Margaret Turner-Bone states: 'Because community nursery
nursing is not registered, many people can undergo any childcare
training and then call themselves a nursery nurse.'

She adds: 'But this does not necessarily mean that they have
the relevant skills and knowledge to work in the community.'

Training and conduct

The Qualifications and Curriculum Authority recommends four
qualifications for community nursery nursing, providing the necessary
theoretical and practical training in child development:

* Diploma in child care and education (DCE) awarded by CACHE
(previously the NNEB) and the HNC in child care and education (Scotland)

* Level 3 BTEC national diploma in early years, awarded by EDEXEL

* NVQ Level 3 in early years and education, awarded by City &
Guilds,

CACHE, EDEXEL and the OU. Barbara Evans comments: 'Unite/CPHVA
has developed a voluntary CNN code--but this is only voluntary. Not only
could registering the service provide a recognised level for training
and raise the professionalism of community nursery nursing within the
NHS, it could provide greater protection for the public.'

She adds: 'Nurses and midwives have a professional code of
conduct that they must adhere to and are held accountable to, and if
community nursery nursing was registered, then the service could be
better regulated. This would mean that CNNs, who often work in skill-mix
teams and make home visits, could be held accountable for their actions
or omissions, and not just delegated to.'

New handbook

The Unite/CPHVA CNN Forum has developed a new handbook for CNNs
that points to information on leadership, record-keeping, lone working
and clinical supervision, as well as advice on tasks such as infant
massage and therapeutic play.

Margaret Turner-Bone states: 'The handbook can be used as a
reference point, which CNNs can dip into for information. There have
been many books published on child care, but this handbook compiles all
of that information into one book.'

She adds: 'There is something in here for everybody and it
could be used to inform and further reinforce the roles of CNNs.'

The new handbook will be launched at Unite/CPHVA annual
professional conference on 14 to 16 October in Southport.

It is clear that there are few existing opportunities within the
NHS for CNNs to progress their careers, despite the benefits associated
with employing senior CNNs. The outlook appears to depend on whether the
leadership shown by some trusts in developing these roles is replicated
by others.

Further information

* The new CNN handbook is due to be launched at the annual
conference, and will be available from Unite/CPHVA

* To access the voluntary CNN code of conduct, see:
www.unite-cphva.org then click on 'Professional groups' and
then 'Nursery nursing'.